The International Skeletal Society is now fifteen years old and as measured in human terms has outgrown its childhood. During this time the ISS has earned worldwide respect and praise for successful work. The International Skeletal Society is an interdisciplinary working group concerned with skeletal diseases, their pathogenesis, diagnosis, and treatment at all ages. At the Annual Closed Meetings of the ISS prominent scientists representing many countries from all over the world gather to exchange ideas in the fields of radiology, pathology, orthopedic surgery, nephrology, and endocrinology. Follow ing these meetings Refresher Courses are offered for students, physicians in train ing, and interested collegues from the various medical specialities. The purpose of these courses is to present the latest developments in clinical practice and research with regard to skeletal diseases. The Society's internationally well-known journal "Skeletal Radiology," which is published by Springer-Verlag, Heidelberg, adds in exchanging updated developments in the field of skeletal disorders. The hereby presented first Book of Members contains a record summarizing the most important milestones and events of the history of the International Skeletal Society up to 1987 in the form of short biographies regarding the members of the Society. The task of gathering all important informations for this book was accom plished by one of the members during his term as President of the ISS. The other one - honorary member - took upon himself the tasks related to publication."

These collected papers represent only a small part of the large amount of new work in the field of stereotaxy. The number of contributions to the Birmingham meeting was such that only selected papers, chosen as representative of advances in the field, could be printed. These papers present the most up to date accounts of major advances in stereotactic imaging and the renewed interest in the stereotactic treatment of movement disorders. Contents Section I. Stereotactic Imaging, Tumours and Haematomas Lipinski, H. G., Struppler, A., Birk, P.: Transformation Modes in Computerized Human Thalamic Brain Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 3 . . . Giunta, F., Marini, G., Bertossi, M.: Stereotactic Computer Graphic System with Brain Maps. . ., 7 Giorgi, c., Cerchiari, U., Broggi, G., Contardi, N., Birk, P., Struppler, A: An Intraoperative Interactive Method to Monitor Stereotactic Functional Procedures . . . . . . . . . . . . . ., . . . 10 Giorgi, c., Cerchiari, u., Broggi, G., Passerini, A.: 3-D Reconstruction of Cerebral Angiography in Stereotactic Neurosurgery . . . . . . . . . . . . . . . . . . . . . . .. . . . 13 . . Vandermeulen, D., Suetens, P., Gybels, J., Oosteriinck, A: Angiographic Localizer Ring for the BRW Stereotactic System . . . . . . . . . . . . . . . . . . . . . . . . . ., . . 15 . . . Uematsu, S., Rosenbaum, A. E., Erozan, Y. S., Gupta, P. K., Moses, H., Nauta, H. J., Rigsby, W. H., Wang, A, Weiderman, L., Kumar, A J.: Intraoperative CT Monitoring During Stereotactic Brain Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 18 . . .

Prior to the virtual atomic explosion of medical knowledge, at a time when communica tion was very much slower, a medical book, to be authoritative and believable, had to be written by a very knowledgable, and, per force, usually quite senior person. The choice of texts was limited and tended to be dominated by a few "classic" (a phrase not quite synonymous with dogma). Following the information explosion, the scenario is quite different. Not only is there a geometric progression in the quantity and speed of devel opment of new medical knowledge, but also this development is occurring at very dif ferent rates in different countries. This is particularly true in medical imaging. The result is that it is now virtually impossible to produce a "single author" book that can cover the field or even a subdivi sion of it. This absolute requirement for multiple authors has in turn created the need for a new type of editor/author who must be multinational in approach, have a uniquely informed appreciation of what is going on in medical imaging research throughout the entire world and possess the depth of personal knowledge and experience to judge cor rectly what work is the most rigorous and likely to have the greatest impact."

Contrast media are drugs by default. Had there been no default, there would be no need for a related pharmacology, and thus no need for this book. Radiographic contrast media (CM) are substances whose primary purpose is to enhance diagnostic information of medical imaging systems. The position of CM in pharmacology is unique. First, there is the unusual requirement of biological inertness. An ideal CM should be completely biologically inert, i.e., stable, not pharmacologically active, and efficiently and innocuously excretable. Because they fail to meet these requirements, CM must be considered drugs. The second unusual aspect of CM is that they are used in large quantities, their annual production being measured in tens of tons. It is not in spite of, but because of, the increased use of new radiographic systems, computed tomography, digital radiography, etc., that consumption is on the rise. And, it is not likely that the other emerging imaging modalities - NMR, ultrasonography, etc. - will displace radiographic CM soon; it is quite probable that these remarkable compounds will continue to play an active role in diagnostic imaging in the foreseeable future.

2. Virological Findings. 90 3. Immunity. . . . . 90 C. Secondary Dengue: Dengue Hemorrhagic Fever and the Shock Syndrome 92 1. General Remarks. . . . . . . . . . . . . . 92 2. Clinical Course and Clinical Laboratory Findings 93 3. Virological and Serological Findings. . . 95 4. Immunopathology of Secondary Dengue. 98 XI. Immunization. . . . . . . . . . . . . . . 104 A. Anamnestic Immune Responses in Sequential Infections With Dengue and Other Group B Togaviruses . . . . . . . . 104 1. Results With Members of the Dengue Subgroup 104 2. Results With Dengue and Other Flaviviruses. 107 B. Dengue Vaccines for Use in Man 108 XII. Opportunities for the Future 113 Acknowledgments. 114 References. . . . . . . . . . . 114 I. Introduction Dengue fever is a mosquito-transmitted disease of man which has afflicted untold millions of people over the past two centuries. It is caused by viruses classified as a subgroup of the group B togaviruses. Along with other members of that group as well as group A, the dengue viruses have been investigated intensively during recent years. Certain unique aspects of their structure, composition, antigenicity, replication, and antigenic relationships have established the togavirus family as quite distinct from other families of enveloped RNA viruses (see recent review of PFEFFERKORN and SHAPIRO, 1974). The basic studies leading to this conclusion have coincided with epidemiological field investigations which have resulted in a continuing increase in the number of viruses now designated as group A or B togaviruses. This, in turn, has led to a growing appreciation of their immense importance as actual or potential pathogens of man and beast.

The brilliant yet simple idea of introducing a catheter percutaneously into an artery, without first dissecting it free, using a flexible guide wire, has led to a truly revolutionary breakthrough in abdominal x-ray diag nosis (SELDINGER, 1953). In the meantime, methods and techniques for injecting contrast media into various vessels have become largely standardized; innumerable publications have appeared which deal with every conceivable aspect of angiographic technique and interpretation. This volume is designed to present our experience with abdominal angiography. We deliberately refrained from any systematic discussion of the genitourinary tract, which has been adequately dealt with in the literature, also with respect to angiographic findings. Our interest in the retroperitoneal region is based mainly on its significance in differential diagnosis. In ten years of angiographic activity, our Department had made successful use of a simple technique which appears suitable also for smaller hospitals. We wish to point out its diagnostic potential and, at the same time, to outline its limitations. Our experience embraces 2804 abdominal angiograms, which we have classified according to clinical and morphologic anatomical criteria. Their diagnostic interpretation has been compared with the surgical or histopathological results. This may help others to avoid errors of the type which we discovered in our own work. Angiographic diagnosis requires not only familiarity with normal radiographic anatomy, but also specific knowledge of angiographic patho morphology. We have tried to identify those features which typify the individual findings and to derive therefrom valid generalizations with the aid of simple sketches.

Clinical trials with Lipiodol l3ll were started in 1961 by my associate, S. CHIAPPA, and a group of physicians at the Institute of Radiology and the National Cancer Institute in Milan and development has been vigorously pursued during the past years. Once the rationale of this method was established, various aspects of the prob lem have been investigated, particularly the distribution of the radioactive dye into the lymph nodes as weIl as its fate and dosimetry in the body tissues. This mono graph describes the extensive clinical evaluation and the radiological results obtained in a large group of patients with malignant lymphomas. Endolymphatic radiotherapy as a therapeutic tool employing radionuclides has aroused interest at several meetings concerned with lymphology. In the re cent mono graph "Lymphography in cancer" by W. A. FUCHS, J. W. DAVIDSON and H. W. FISCHER, Dr. JANTET wrote a chapter on this specific subject. Many aspects are still debated, i. e. the choice of radionuclide, the specific clinical indications and the proper evaluation of the therapeutic effects. It is hoped that further studies will come to more precise conclusions."

Numerous diseases in the areas of orthopaedics, rheumatology, and radiology can only be completely diagnosed if the corresponding conditions of the skin and mucous membranes are included in the diagnostic work-up (skin-bone). Conversely, dermatologic assessment of skin symptoms in isolation may lead to serious delays and errors in the diagnosis and treatment of associated changes in the musculoskeletal system. This monograph gives an interdisciplinary synopsis, from a dermatologic and clinical radiologic perspective, of 85 disease entities which in practice are likley to present. For orientation purposes the main dermatologic and radiologic symptoms are presented in table form at the beginning of the book.

The larvae of Anisakis, whose adult form lives on sea mammals such as whales, seals, and dolphins, are parasitic upon many species of salt-water fish. When the final host animals eat paratenic hosts, the larvae grow to adulthood in the hosts' stomach. However, when hu mans eat these infested fish, the larvae die instead, causing a disease called anisakiasis. In 1960, in the Netherlands, van Thiel et al. found a worm in the intestinal wall of a patient who had eaten raw herring and had suffered symptoms of acute abdomen. The impact of this report was tremendous among Japanese parasitologists because of the Japanese habit of eating raw fish. In 1964, the Special Research Group from the Ministry of Education was established to investigate the disease, stimulating progress in the study of anisakiasis. Three types of worm, Anisakis simplex larva (previously known as Anisakis larva type I), Anisakis physeteris larva (Anisakis larva type II), and Pseudoterranova decipiens larva type A, are believed to cause anisakiasis. As many as 165 kinds of fish and squid in the seas near Japan are hosts to Anisakis simplex, and 9 species are hosts to Pseudoterranova decipiens larvae. Contra caecum has experimentally been observed to invade the gastrointestinal tract, but no infection by this larva has been reported in humans. A case of infection by Pseudoterranova decipiens type B has been described. In Japan, the name Terranova decipiens (Shiraki 1974) has been adopted instead of Phocanema decipiens (Mozgovoi 1953)."

Scientists and engineers have been involved in medical radiology from the very beginning. At times advances in this field occur at a tremen dously fast pace. Developments in radiological diagnostics have - technologically and medically speaking - focused on morphology. At present, computer-aided tomography (CAT) is at a high point in deve1opment, medical application, and validation. The preconditions for this success were rapid advances in electronics and computer technology - in hardware and in software - and an unexpected cost reduction in these fields; the co operation of various scientific disci plines was also essential. Functional radiological diagnosis has been neglected in part, owing to the emphasis on morphology, but alone the synthesis of morphology and function prornises further advances. Apart from the limited capabilities ofuItrasonic techniques there is no way other than using X-rays to carry out functional studies of organs and their systems through an intact body surface. It is frequently necessary to do further processing and evaluation of image series which have been recorded from the morphological viewpoint. This further picture processing may be of selected points (pixels) in the image, of certain regions of interest (ROI), or of the overall picture. For the measure ment of rapid phenomena, such as the blood flow in the main arteries, high image-frame rates are required, and at the moment these can only be achieved with cinemascopic techniques. For slower processes, other techniques such as videography have some advan tages.

Various textbooks on stereotactic neurosurgery have been published during the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), all of them dealing with functional stereo tactics as the major subject in the field. Diagnostic and therapeutic stereotactic interventions are only briefly described, whereas localization techniques are not yet mentioned. Since 1980, however, an increasing number of reports has been published on CT guided and computer monitored stereotactic performances which enable the surgeon to combine diagnostic and therapeutic efforts in one session. With recent progress in scanning techniques, including high resolution CT, NMR, and PET imaging of the brain, it has become possible to study and localize any brain area of interest. With the concomitant advances in computer technology, 3-dimensional reconstruction of deep seated lesions in stereotactic space is possible and the way is open for combined surgery with stereotactic precision and computer guided open resection. This type of open surgery in stereotactic space is already being developed in some centers with the aid of microsurgical, fiberoptic, and laser beam instrumentation. With these advances stereotactic techniques will rapidly become in tegrated into clinical neurosurgery. Stereotactics has become a metho dology which enables the surgeon to attack deep seated and subcortical small tumors. Neurosurgeons may abandon therapeutic nihilism, still frequently seen in glioma treatment, in the near future when stereotactic resection will be feasible and remaining tumor cells may be killed by adjuvant treatment modalities still in development."

Up until two decades ago, clinical interest in the etiopathogenetic interpretation of lumbo-radicular syndromes was prevalently concentrated on the pathology of the inter vertebral disc. This vision gradually changed and grew as a result of the affirmation of the concept of pathological narrowing of the osteoligamentous vertebral canal as a cause of compression of the lumbar nervous structures. Finally, in the last ten years, lumbar stenosis has become more and more a subject of current interest not only as a result of problems related to nosography, diagnosis, and therapy, but also as a result of the increasing frequency with which vertebral canal or nerve root canal stenosis syndromes are recognized and treated. At the same time there was a tendency to include in stenotic pathology other pathological conditions responsible for lumbo-radicular syndromes. This led to dilation of the concept of stenosis, which perhaps no longer responded to reality, and which was not useful from a practical point of view. The need to define stenotic pathology and to correctly locate it within the vast field of lumbar pathology inspired the writing of this volume. This monograph gathers many diagnostic and therapeutic concepts matured at our In stitution over the years. Some of these concepts have already been defined in scientific meet ings or in publications."

Spontaneous intracerebral haemorrhages are the most dangerous complication of cerebral vascular disease. Because of their frequency and the fact that they lead to serious injuries, prolonged disabilities and, often, death, they have acquired an enormous significance, both medically and socially. Their precise diagnosis, location, wide extent and accomp ying manifestations were for a very long time uncertain and, in small and deeply situated haematomas, these factors were impossible to determine. Diagnosis was confirmed by the clinical picture, by angiography and sometimes by ventriculography and included, in the main, both lobar and more extensive haematomas. The results of operative treatment following the first attempt of H. Cushing in 1903 were poor and remained unsatisfactory in spite of the endeavours of numerous authors (Guillaume et al. 1956; Lazorthes 1956; McKissock et al. 1959; Luessenhop 1967 and many others). Especially for the most frequent and typically hypertensive haematomas in the region of the internal, capsule, the opinion was often expressed that operative treatment was useless.

In the 1960s a firm rationale was developed for using raised temperatures to treat malignant disease and there has been a continuous expansion of the field ever since. However, a major limitation exists in our ability to heat human tumours, especially those sited deep in the body, with a reasonable degree of temperature uniformity. This problem has resulted in engineers and physicists collaborating closely with biologists and clinicians towards the common goal of developing and testing the clinical potential of this exciting treatment modality. The aim of the physicist and engineer is to develop acceptible methods of heating tumQur masses in as many sites as possible to therapeutic temperatures avoiding excessive heating of normal structures and, at the same time, obtaining the temperature distribution throughout the heated volume. The problem is magnified by both the theoretical and technical limitations of heating methods and devices. Moreover, the modelling of external deposition of energy in tissue and knowledge of tissue perfusion are ill-defined. To this must be added the conceptual difficulty of defining a thermal dose. The NATO course was designed to provide a basis for the integration of physics and technology relevant to the development of hyperthermia. There were 48 lectures covering the theoretical and practical aspects of system design and assessment, including, as far as possible, all the techniques of current interest and importance in the field.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was fust discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo KrayenbUhl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the fust part of each volume."

Pediatric body CT began in earnest in 1976 when for the first time a body CT machine was installed in a pediatric institution, the Hospital for Sick Children in Toronto. The first images were received with great enthusiasm. More recently, newer equipment with faster scan times and better resolution has enabled us to delineate disease processes with even greater accuracy. In the past 9 years we have performed more than 5000 body scans in children. With this experience our examination techniques have changed and the indications for CT in children have been modified. CT has come to occupy an important and specific place in the management of pediatric patients. The performance of body CT studies in children is not always easy. Excellent diagnostic studies can be obtained only with a special understanding of the problems of pediatric patients and pediatric pathology. The information contained herein is a review of our experience with pediatric body CT, how we use body CT in children, and its relationship to other modalities in this department.

I am particularly pleased to be able to write the introduction to this book that resulted from a collaborative effort by the Radiology De partment, under the auspices of the Boerhaave Committee for Postgraduate Medical Education of the Faculty of Medicine, at the University of Leiden and the Department of Medical Imaging and Radiological Sciences at Van derbilt University. Magnetic resonance imaging affords the opportunity to interrogate organ and system structure and function in a nondestructive manner without se rious biological implications. Tissue contrast with this modality is ex quisite and inherently superior to that of x-ray computed tomography. The advances to improve signal capture, development of rapid data acquisition techniques, fabrication of more appropriate pulse sequences, and availa bility of contrast agents portend increased versatility and specificity of these studies. Despite the proliferation of numerous general and specialized texts, the developments in MRI occur at such a pace that data in these references are necessarily dated. The technical horizon of MRI is vast with almost li mitless possibilities of signal generation and plan reconstruction. Tissue contrast is so importantly affected by the coupling of signal generation and capture that collective experience of institutions and investigators is extremely important to the initiate and useful even to those indivi duals with the greatest clinical experience."

It is with pleasure that I write this foreword for the book "Magnetic Resonance Imaging in Coronary Artery Disease", edited by Dr. van der Wall and Dr. de Roos. I am pleased for two reasons. Firstly, as chairman of the Scientific Board of the Interuniversity Cardiology Institute of the Netherlands (ICIN), because ever since the technique became available for use in medicine and biology our Institute has tried and succeeded to promote the introduction and dev- opment of magnetic resonance imaging in cardiology in the Netherlands. ICIN was the first cardiological institute on the European continent to purchase its own nuclear magnetic resonance spectroscope for the study of myocardial metabolism. Secondly, because I have always been infatuated with this noninvasive technique that can produce cardiac images without ionic radiation and at the same time allows for the study of myocardial metabolism as well. And even more so because nuclear magnetic resonance imaging in medicine is one of the shining examples of medical progress as a result of breakthrough discoveries in physics and chemistry.

..". I would recommend this book for an in-depth analysis of the lumbar spine and its degenerative states ... extremely beneficial for the resident early in trainings as he or she attempts to correlate the complex anatomy of the lumbosacral region with associated pathological states ... Journal of Neurosurgery"

In the last few years, increasing effort has been devoted to better define the characteristics of tissue damage occurring outside MRI-visible lesions in patients with multiple sclerosis (MS) and, as a consequence, to improve our understanding of the disease pathobiology and of the mechanisms leading to the accumulation of irreversible disability. This book provides an updated review of the results obtained by leading research groups in this field. The potential clinical applications of what has been shown so far, as well as the areas for future research in the study of normal-appearing white and gray matter damage in MS are extensively discussed, making this book a valuable tool for clinical neurologists who are involved in the daily-life care of MS patients and for neuroscientists involved in MS research.

In nearly all areas of technology our generation is experiencing the phenomena of fast paced innovation and great bursts in development. Besides the completely new techniques, the "experienced user" is astonished when obviously good and appar ently matured technology such as the next to last generation of CT equipment undergoes further development, such as is the case with the spiral CT technique. The enormous potential of spiral CT suddenly became apparent, stimulating and giving rise to a wide range of research on its clinical application. Yet again we can see in the field of imaging how great advances in one method competitively affect the range of application in another. Hence it is extremely valuable and necessary to appraise the current situation now. Both physicians - who use the equipment - and the health system and with this the patient - which finances it - have the obligation and the right to permanent optimization of the application strategies of diagnostic procedures. Not least, this symposium also meant to fit the new voice of spiral CT harmo niously into the symphonic score of diagnostic procedures. The large radiodiagno stic department ofthe university clinics which has been established at the Neues All gemeines Krankenhaus in Vienna, Austria, is proud to have jointly arranged this user symposium with Siemens."

Contents: Intracranial Pressure and Mass Displacements of the Intracranial Contents. - Special Neuropathology - Morphology and Biology of the Space-Occupying and Atrophic Processes with Their Related Neuroradiological Changes of Diagnostic Significance. - Cerebral Angiography. - Pneumoencephalography. - Myelography. - Spinal Angiography. - Discography. - Ossovenography and Epidural Venography. - References. - Subject Index.

Contents Abdominal and Thoracic Magnetic Resonance Angiography: Challenges, Technical Approaches and First Clinical Applications. H.U. Kauczor, R. Hausmann, W. Semmler Magnetic Resonance Spectroscopy of Skeletal Muscle. F. Tr{ber, W.A. Kaiser, G. Layer, C. Kuhl, M. Reiser Hepatic Tumors: Relaxometry and Quantitative Tissue Characterization with Magnetic Resonance Imaging. A. Steudel, F. Tr{ber, M. Reiser Liver-Specific Particulate Contrast Agents: An Overview I. Ivancev, A. Lunderquist Contrast Medium Induced Nephropathy: Animal Experiments H.S. Thomsen et al. Rheological Properties of Blood after Diagnostic Cardiac Catheterisation with Iopromide. R. Bach et al. Color Coded Doppler Sonography of the Male Urethra During Voiding: New Observations of Flow in an Aqueous Medium and Their Physical Foundations. P. H}bsch, F. Hager, E. Benes Development of a Model of Arterial Stenosis Analysis Using Digital Subtraction Angiography: A Parametric Study of Image Quality. C. Renaudin, I. Magnin, A. Amiel Arterial Calcifications in Thoracoabdominal Computer Tomography: Frequency and Correlation with Risk Factors and Cardiovascular Diseases. J. G-rich et al.

The eighth annual multidisciplinary symposium on clinical oncol ogy organised by the Royal College of Radiologists discussed the subject of investigational techniques in oncology. It was held in London in February 1986. This volume collects together the edited texts of the papers which were presented at the meeting, together with the George Edelstyn memorial lecture given by Professor J. Einhorn. Clinicians rely very heavily on pathologists and radiologists to help with the diagnosis and staging of patients who present with malignant tumours. The conventional techniques to which we have become accustomed are fast being supplemented by exciting new approaches. These have moved very rapidly from being purely experimental techniques to being a part of routine clinical practice. Some of these new approaches have been highlighted in this symposium. Recent advances in molecular biology have produced various specific techniques for looking at phenotypic changes in cells as detected by immunohistochemical probes. Visualisation of genes and their transcripts in human biopsies has become a real possibility using a wide and increasing range of molecular probes. Some of the advantages of these techniques and their potential for the future are presented here."